Safe Travel to India

Posted by Stuart Rose on Jan 07, 2017

Travel Safety Guidelines for India

There is significant risk of illness when traveling to India. The risks to health, however, will vary between individuals and you need to take into account your activities (e.g., exposure to high altitudes, to animals, travel to remote locations), your length of stay and your general health. Many problems cannot be prevented by vaccinations (dengue fever, paratyphoid fever) and you need to take other preventive measures outlined below.

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Immunizations

Confirm primary courses and boosters are up to date, including for example, vaccines required for occupational risk of exposure, lifestyle risks and underlying medical conditions.

Vaccines or boosters usually advised: Diphtheria (usually combined with tetanus); Hepatitis A; Tetanus (Tdap); Typhoid. The typhoid vaccine is 75% effective, not 100%, because it does not prevent paratyphoid fever.

Other vaccines to consider: Hepatitis B; Japanese Encephalitis; Rabies.

Yellow fever vaccination certificaterequirements for India are specific. Basically, you will need a Yellow Fever Vaccination Certificate if you are arriving from a country where there is YF.

Notes on the diseases mentioned above

Cholera: spread through consumption of contaminated water and food. This disease is very rare if you take take basic precautions with food and water and maintain a good standard of hygiene (wash hands!). A cholera vaccine has just become available in the U.S. but is recommended mostly for health care or relief workers.

Tetanus: spread through contamination of cuts, burns and wounds. Boosters are usually recommended in a country or situation where the correct treatment of an injury may not be readily available.

Problem: You don’t want to get a medical injection in countries where the sterility of the needles may be questionable. Get a tetanus shot before departure, if needed. Be sure to thoroughly clean and dress any wound with an antibiotic ointment and sterile dressing.

Diphtheria: Vaccine is always combined with the tetanus (Tdap or Td) vaccine.

Hepatitis A: spread through consuming contaminated food and water or person to person through the fecal-oral route. Risk is higher where personal hygiene and sanitation are poor. This is a very important vaccine to get if not previously immunized.

Japanese Encephalitis:spread through the bite of an infected mosquito. This mosquito breeds in rice paddies and mainly bites between dusk and dawn. Risk is higher for long stay (3-4 weeks) travelers to rural areas, particularly if unable to avoid mosquito bites. Expensive. Two shots, 28 days apart, are needed.

Rabies: spread through the saliva of an infected animal, usually through a bite, scratch or lick on broken skin. Dogs are the main risk and the most cases in the world occur in India. Risk is higher if you are going to remote areas (where you may not be able to promptly access appropriate treatment in the event of a bite), long stays, those at higher risk of contact with animals, and children. Even if you get the pre-exposure vaccine, you will need 2 booster doses of rabies vaccine, given 3 days apart. Get urgent medical advice after any animal (or bat) bite.

Typhoid: India has the highest risk of typhoid fever in the world. Typhoid fever spread mainly through consumption of contaminated food and drink. The vaccine is not 100% effective because it does not prevent paratyphoid fever. Symptoms include fever, abdominal pain, and constipation. Untreated fatality rate is 40%. You can take azithromycin (probably prescribed for you for travelers’ diarrhea) if you have these symptoms, but see a doctor ASAP. A 7-days course of azithromycin is usually effective if you have an uncomplicated case.

Malaria

Malaria is a serious and sometimes fatal disease transmitted by mosquitoes. You cannot be vaccinated against malaria. You can prevent malaria by preventing evening and nighttime mosquito bites and taking anti-malarial medications, although delayed attacks of Vivax malaria are still possible despite taking the meds.

Low risk with additional advice: antimalarial tablets are not usually recommended, however, if you stay longer in rural areas, visit friends or relatives, or have a chronic medical condition, malaria pill may be appropriate,

Low to no risk: Antimalarial tablets are not usually advised, but if you have been traveling in a malarious area and develop a fever seek medical attention promptly. Remember malaria can develop even up to one year after exposure.

If traveling to high risk malarious areas, remote from medical facilities, carrying emergency malaria medication may be considered. (Self-treatment with Malarone is usually recommended: 4 tablets once daily x 3 days).

Other Health Risks

Dengue Fever & Chikungunya Fever

These viral illnesses are transmitted to humans by daytime mosquito bites and are more common in urban areas. Symptoms include fever, headache, severe joint, bone and muscular pain - hence the name 'breakbone fever'. There is no vaccine and prevention is through avoidance of daytime bites. Use DEET on exposed skin and permethrin on your clothing.

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About the Author

Stuart R. Rose, MD, the author of The International Travel Health Guide, founded Travel Medicine, Inc. in 1989. Dr. Rose was educated at Amherst College and Columbia University College of Physicians and Surgeons. He is board certified in emergency medicine and internal medicine, and is a fellow of the American College of Emergency Physicians.

Dr. Rose is the Director of the Travel Medicine Center of Western Massachusetts in Northampton and attending physician in the Department of Emergency Medicine at Noble Baystate Hospital in Westfield, Massachusetts. He is a member of the American Society of Tropical Medicine and Hygiene and the International Society of Travel Medicine. The International Travel Health Guide is available online.